Background: Inflammatory bowel disease (IBD) is associated with systemic inflammation and potential cardiovascular complications. This meta-analysis evaluates long-term cardiovascular risks in IBD. Methods: Electronic databases were searched for studies examining cardiovascular, cerebrovascular, and thromboembolic risks in IBD. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Fifty-three studies comprising 1,406,773 patients were analyzed. IBD was linked to increased risk of ischemic heart disease (aHR 1.25; p = 0.001) myocardial infarction (aHR 1.25; p = 0.01), acute coronary syndrome (aHR 1.43; p < 0.00001), heart failure (aHR 1.24; p < 0.00001), atrial fibrillation (aHR 1.20; p < 0.00001), and stroke (aHR 1.13; p < 0.00001). Elevated risks were also observed for peripheral arterial disease (aHR 1.41; p < 0.00001), diabetes mellitus (aHR 1.40; p < 0.00001), venous thromboembolism (aHR 1.98; p < 0.00001), deep vein thrombosis (aHR 2.85; p = 0.0004), and pulmonary embolism (aHR 1.98; p = 0.03). Importantly, IBD was associated with increased cardiovascular (aHR 1.14; p = 0.03) and all-cause mortality (aHR 1.53; p < 0.00001). Conclusions: IBD patients face higher risk for adverse cardiovascular outcomes, thromboembolic disease, and mortality, necessitating early cardiovascular risk assessment and targeted interventions in this population.

Background: Dual antiplatelet therapy is an essential component in the management of acute coronary syndrome (ACS) but with a significant risk of bleeding. Newer third-generation P2Y12 inhibitors have proven to be more efficacious but have increased the risk of bleeding. This meta-analysis will study the difference in risk of gastrointestinal bleeding in clopidogrel vs. third-generation oral P2Y12 inhibitors. Methods: A literature search was done in two databases (PubMed/Medline and Cochrane Central). All studies meeting the inclusion criteria assessing the occurrence of gastrointestinal bleeding following the use of oral third-generation P2Y12 inhibitors or clopidogrel were systematically identified. A random-effects meta-analysis evaluated the two arms’ risk ratios (RR). Results: A total of 16 studies were included in our analysis, 11 of which compared ticagrelor to clopidogrel and 5 of which compared prasugrel to clopidogrel. The combined risk for both third-generation P2Y12 inhibitors, Ticagrelor and Prasugrel, was as follows [RR: 1.31 (1.15–1.49); P < 0.0001]. Heterogeneity was reported to be I ² = 4%. Conclusion: Oral third-generation P2Y12 inhibitors were associated with an increased occurrence of gastrointestinal bleeding compared to clopidogrel.

Fibrosis in Crohn’s Disease (CD) occurs when there is continuous inflammation and repair mechanisms, which may lead to fibrotic strictures and ultimately intestinal surgical resection. There are limited non-invasive biomarkers for monitoring CD activity, particularly for detecting fibrosis. Thus, we set out to identify biomarkers that could be monitored for the detection and treatment of fibrosis. We used multiplex protein arrays to examine cytokines and pro-fibrotic factors in the serum of CD patients and analyzed their reliability to predict fibrosis. These markers were confirmed in tissues and the role of cytokines in upregulating fibrotic factors was examined. Collagen 1A1, Fibronectin, MMP9, and Timp-1 in patient serum were identified as strong predictors of fibrosis. IL-1β, MCP-1 and TNFα were identified as major regulators of fibrosis factors in human tissues. Overall, we identified four serum markers that are strong indicators of fibrosis and provided some novel insight into the impact of cytokines on fibrotic factors. Taken together, these findings may lead to earlier detection of fibrosis, and improved monitoring and treatment for CD patients.

Hepatorenal syndrome (HRS) is characterized by severe renal dysfunction associated with decompensated liver cirrhosis, leading to high morbidity and mortality. This study aims to assess disparities in HRS-related mortality stratified by sex, race/ethnicity, and geographic location in the U.S. We analyzed death certificate data from the CDC WONDER database for adults aged ≥ 15 years. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Joinpoint regression was used to assess annual percent change (APC) in AAMRs, with P < .05 considered significant. A total of 95,537 deaths were attributed to HRS-related mortality between 1999 and 2020. The overall AAMR declined from 1999 to 2007 (APC: −3.70; 95% CI: −5.14 to −2.84) followed by stable trend till 2018 (APC: 0.13; 95% CI: −0.74 to 0.87) and then showed a sudden increase till 2020 (APC: 9.16; 95% CI: 3.48–11.89). Men had higher AAMR than women. Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR, followed by Hispanic or Latinos, NH Whites, NH Black or African Americans and NH Asian or Pacific Islander. Variations were evident across regions with the West region having highest AAMR, followed by South, Northeast and Midwest regions. Mortality was the highest in nonmetropolitan areas. HRS-related mortality in the U.S. has increased since 2018, with significant disparities across sex, race/ethnicity and region. Improving healthcare access in underserved areas is essential to addressing disparities and reducing the burden of HRS-related mortality among high-risk populations in the U.S.

A 60-year-old woman with acute severe Crohn's colitis had a rapid initial response to off-label, high-intensity upadacitinib; however, she subsequently demonstrated clinical deterioration ultimately undergoing colectomy for suspected refractory Crohn's disease. Surgical pathology unexpectedly revealed quiescent Crohn's disease with cytomegalovirus colitis, despite no initial endoscopic evidence of infection.